Why Wellness Sells: Natural Health in a Pharmaceutical Culture. Colleen Derkatch. Baltimore, MD: Johns Hopkins University Press, 2022. 272 pages, $50.00 hardcover, $50.00 e-book.
Publisher webpage: https://www.press.jhu.edu/books/title/12718/why-wellness-sells
Reviewed by Brittany Smart (she/her)
University of Louisville
Posted February 2024
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Colleen Derkatch’s recent work, Why Wellness Sells (2022), chiefly argues that the rhetoric of wellness is self-generating. To illustrate this idea, Derkatch draws on rhetoric of health and medicine (RHM) scholar Lisa Keränen’s uptake of autopoiesis (self-generation)—from sociologist Niklas Luhmann’s metaphorical application in social systems theory— to contend that what it means to be well is a “moving target” (p. 5). Wellness is constantly evolving, due to the motivation to both heal and “enhance” our bodies. It’s a never-ending feedback loop. By studying how the discourse around wellness is autopoietic, we can recognize how wellness is not just personal but a powerful cultural phenomenon, shaped by systems that significantly influence our view of health.
Derkatch uses each chapter of her book to demonstrate a specific aspect or “vector” of wellness as it relates to the “logics” of enhancement and restoration. Vectors of wellness appear in the following order: incipient illness, self-management, harm reduction, survival strategy, optimization, and performance. Chapter one opens with the idea of “wellness monitoring,” where Derkatch illustrates how wellness culture encourages intense self-surveillance in order to locate any deficiencies so that they might be restored. She then explains how this monitoring of wellness, paradoxically, utilizes the same frames and language of managing illness in its attention to bodily states. This chapter is key to the text in its detailed outlining of Derkatch’s framework of autopoiesis as it relates to wellness. Derkatch explains how the logics of enhancement and restoration self-generate through discourse on wellness by analyzing data from 40 interviews that she conducted in Canada (where she is based) in 2015 and 2018. Her participants likened wellness to “a math problem,” where they attempted to quantify how close they are to “100” and tried not to fall too far below (p. 31). At its root, Derkatch argues, wellness culture assumes everyone is “incipiently ill,” thus broadening opportunities to sell treatments for suboptimal conditions of mind and body.
In chapter two, Derkatch describes “self-management” as a vector of wellness. She introduces the chapter by arguing that because the onus is on individuals to handle their own health needs, wellness culture requires people to locate and purchase their own remedies, and, as a result, “wellness” sells—and it sells well. Because governing institutions have passed the primary responsibility of health down to individual citizens, markets are encouraged to advertise wellness as a commodity. Derkatch demonstrates this phenomenon by examining public criticism regarding a Canadian parliamentary bill (C-51) that would have added more regulations and consumer protections to the open health market. Her analysis illustrates that while public discourse in a petition protesting the bill did indicate a desire for more agency in decision-making about healthcare products, the situation as a whole may instead reveal the ways in which individuals are expected to self-regulate their own health as “good wellness citizens” (p. 49). This framing minimizes addressing health problems (and other societal issues) as systemic, thus removing culpability from governments and institutions to create equitable solutions for the public good. Chapter three builds on chapter two’s wellness vector, as Derkatch argues that if health is to be self-managed, it is then the responsibility of an individual person to assess and shield themselves from risk. Derkatch refers to this vector of wellness as “harm reduction,” which is enacted when the harm in question cannot be avoided. To explore how this term functions in relation to wellness, she examines several cultural artifacts (such as advertisements and the aforementioned C-51 petition) that speak to this principle, illuminating how the vector of harm reduction generates discourse on wellness. Because health risks always exist in some form or another and can often be invisible (e.g., in the case of toxins), the aim to eliminate risk (or “detoxify”) completely is impossible.
Chapter four’s key ideas revolve around the notion of exhaustion as a catalyst for the following vector of wellness, which is wellness as a “survival strategy.” Derkatch argues that in our overworked, burned-out society, we come to identify survival mechanisms that help give us a sense of control over our health, such as taking supplements to give us energy, in order to still be productive in a capitalist culture. To explore these ideas, Derkatch draws upon her interview data and foundational literature on rhetorics of resilience, demonstrating how the use of wellness products, while helping one “bounce back” in the short term, often fails to address “root causes” that lead to conditions like extreme burnout (p. 113). Although attending to wellness can make us feel good on an individual level, Derkatch notes, wellness culture can paper over issues like mass societal fatigue, which has enduring consequences. Given that exhaustion is a key component of wellness, Derkatch argues, it stands to reason that optimization exists at its opposite end, as exhaustion’s “more ambitious twin” (p. 139). In chapter five, Derkatch explores the vector of “optimization” in wellness culture through the logic of enhancement, which seeks to improve the body toward a measure of perfection, rather than just patch up and move on (restoration). Derkatch reveals how optimization happens through self-managed “tracking” and “hacking.” Tracking involves intense bodily surveillance that informs actions taken to improve performance. Self-hacking involves taking supplements to maximize targeted health areas, such as youthfulness, energy, and immune system functioning. For example, Derkatch notes that her study participants wanted their bodies to “work smarter, not harder” as kinds of efficiency machines (p. 166). However, Derkatch argues, this tracking and hacking feeds into a never-ending cycle of needing to be better and more optimized—a loop that is compulsive and, consequently, inextricably linked to identity.
The final chapter considers the ways in which the vectors of wellness manifest as particular “performances,” or scripted routines in which wellness is “enacted and embodied” (p. 171). Derkatch discusses how morality is attached to wellness, considering the kinds of affective responses we have to either working or not working toward it (e.g., guilt, pleasure, etc.) and unpacking how these kinds of moral underpinnings spread and proliferate. She argues that these routines or “rituals” we perform for wellness are not only for ourselves, but others as well, and how we perform them depends on our beliefs of what is good (“pious”) or bad for our bodies; performing wellness is, ultimately, how we come to identify, telling us “who and how we ought to be” (p. 174). Derkatch concludes that in its turn inward, in its performativity, wellness culture inhibits the true “self-transformation” that it seeks. Finally, Derkatch summarizes her book’s key ideas by arguing that, because notions of wellness are never-ending (there is no “ceiling” for this discourse), fueled by logics of enhancement and restoration, wellness itself is unattainable. As Derkatch notes, the underlying rhetoric of wellness implies we could always be doing more to fix ourselves and enhance our bodies; we are never sleeping enough, exercising enough, taking enough vitamins, etc. These ideas behind wellness, as Derkatch demonstrates, are ever self-generating. However, by “cracking the atom” of how wellness rhetoric operates, we can gain insight into how to combat its more damaging effects on our culture (p. 211).
Derkatch’s book ultimately uncovers the embeddedness of wellness ideologies and values within our capitalistic culture and social systems. Even as wellness is difficult to pin down and define conceptually, as her interviews with participants indicate, wellness is intricately linked to every part of our society. Thus, there are very few places where its discourse cannot be found in some shape or another. While some of her participants’ notions of wellness appeared to be a sort of “homeostasis” or holistic balance of health, their conceptualizations sometimes shifted between the logics of restoration and enhancement that Derkatch maps out for readers. Derkatch’s argument that rhetorics of wellness are self-generating and pervasive throughout every aspect of our lives is not only compelling but extremely persuasive. Starting with the premise of wellness as incipient illness, Derkatch shows us how considerably we are expected to detect and micro-analyze our own deficiencies—even if they are just the parts that make us human. Wellness culture, essentially, depends on the assumption that none of us are well—or will ever be well—because it is only in our awareness of what is wrong with us that we can try to be “well.” Wellness is unattainable, because perfection is unattainable; after all, we are not machines.
Because each of the chapters builds on one another, readers are able to easily latch onto the framework Derkatch meticulously sets up. To unpack how wellness culture self-generates, we must first try to contend with what wellness is—particularly its subjectivity and dependence on individual buy-in. Once we understand wellness’s intangibility, its continuously evolving metrics of what is “enough,” we can understand the enormity of asking for it to be self-managed. When we know the burden is on individuals to track and reduce harm to themselves, we can see how that idea allows governments and corporations to neglect systemic issues, such as health problems caused by pollution or overworking. Not only does placing the responsibility of wellness on individual citizens take incentives away for organizations to reduce labor expectations or cut back on emissions, but it ensures people are just fixing themselves to survive this system day to day without any extra expenditures on the organizations’ part, as well as unceasingly optimizing to meet personal and professional bottom lines. Consequently, we can see how all of these ideologies manifest in personal and public identity; as Derkatch writes, if we aim to meet these measures, we can be considered “good citizens.” Derkatch weaves these ideas through extensive qualitative evidence, derived from her own comprehensive interviews, along with anecdotes from her personal life and cultural artifacts such as political documents and public commentary, advertising campaigns, and social media trends, among others. Many of these examples, particularly those related to marketing and social media are ones likely all of us come across every single day. Upon reviewing Derkatch’s argument, it is clear to me that rhetorics of wellness are inescapable.
This book is not only relevant to RHM as a field but timely with the presumed exodus of COVID-19 (LaFraniere & Weiland, 2023) and the rise in chronic illnesses and disability because of the pandemic (Hacker, et al, 2021; HHS, 2021). As people come to terms with long Covid, cope with new bouts of the illness, or work to avoid getting the virus altogether the focus again centers on what individuals can do to reduce harm to their health or fix the problem themselves. Derkatch’s argument about the influence of the “market model of medicine” on our culture will be important to consider in the years to come, as people gravitate toward “natural” supplements instead of vaccines, homeopathic remedies over evidence-based treatment, and wellness influencers rather than board-certified physicians (p. 62). Within RHM, the book extends conversations that reflect the impact of capitalistic ideals on health-related public discourse and the subsequent internalization of these expectations, notably regarding all the ways in which individuals are consumers who must take charge of their own health and partake in the marketplace of medicine.
Overall, Derkatch’s work is a must-read for all within RHM, as its ideas have significant implications for every area of our field. Readers will gain key insights into how the self-generating discourse of wellness affects our day-to-day lives, as well as how it functions in exacerbating health inequity writ large. Why Wellness Sells: Natural Health in a Pharmaceutical Culture is an important text that demonstrates the pervasiveness of wellness culture and how its tendrils are tightly woven within the fabric of our society—and how we might untangle those threads to understand how they constrict, rather than expand, our understanding of health.
References
Hacker, K. A., Briss, P. A., Richardson, L., Wright, J., & Petersen, R. (2021). COVID-19 and chronic disease: The impact now and in the future. Preventing Chronic Disease, 18. DOI: http://dx.doi.org/10.5888/pcd18.210086external icon
LaFraniere, Sharon, & Weiland, Noah. (2023, January 30). U.S. plans to end public health emergency for Covid in May. New York Times. https://www.nytimes.com/2023/01/30/us/politics/biden-covid-public-health-emergency.html
U.S. Department of Health & Human Services. (2021, July 26). Guidance on “long COVID” as a disability under the ADA, section 504, and section 1557. HHS.gov. https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/guidance-long-covid-disability/index.html
